Healthcare Provider Details

I. General information

NPI: 1487040267
Provider Name (Legal Business Name): CDC GROUP SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CALLE ESTRELLA
PONCE PR
00730-3832
US

IV. Provider business mailing address

PO BOX 893
JUANA DIAZ PR
00795-0893
US

V. Phone/Fax

Practice location:
  • Phone: 787-598-4528
  • Fax:
Mailing address:
  • Phone: 787-598-4528
  • Fax: 787-837-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4010
License Number StatePR

VIII. Authorized Official

Name: MRS. DELGIA CRUZ
Title or Position: ADMINISTRATOR
Credential: CPL
Phone: 787-598-4528